Global biotech entrepreneur Vishal Doshi explores the potential of biotechnology in transforming cancer therapeutics. Moving beyond conventional cancer therapies, Vishal believes that innovations in precision oncology therapeutics can bridge the gaps in cancer care, transforming the future of cancer treatment.
by Vishal Doshi
Cancer is the second leading cause of death worldwide. Characterised by the uncontrolled growth of cells in any part of the body, cancers can metastasise to other areas of the body as well,1 with the most common cancer sites being lung (13.8%), breast (10.8%), colorectum (10.5%), stomach (8.6%) and liver (6.9%).2 Asia bears nearly half of the global cancer burden alone, with an alarming estimate of 49.3% of new cases and 58.3% of cancer deaths in 2020.2 Moreover, estimates from the International Agency for Research on Cancer suggest that cancer incidence in Asia is projected to increase from 9.5 million (2020) to 15.1 million (2040) and deaths will rise from 5.81 million to 9.86 million respectively.3
This surge in cancer burden is largely attributed to socioeconomic growth, urbanisation, lifestyle changes, and an ageing and growing population. With Asia being the most populous region in the world, nearly 25% of the population is expected to be ≥60 years by 2050. Other factors such as lack of physical activity, obesity, unhealthy dietary patterns, increased tobacco use, and rising prevalence of diabetes, hypertension, and lipid disorders play a crucial role in elevating the number of cancer cases.4
Moving Beyond Conventional Cancer Therapies
In general, cancer treatment aims to kill all cancer cells or to stop their growth. It primarily includes surgery, chemotherapy, radiation therapy with high doses of radiation, or a combination of these.5 However, resistance to both single and a combination of chemotherapeutic agents has been observed,6 and it was found that the majority of cancer deaths occur due to relapses after treatment.7 As every cancer patient is unique and the mechanisms of drug resistance vary widely, cancer treatment can be extremely complex.7 It is this complexity that continues to exert pressure on healthcare systems, driving the need for innovation to develop more personalised and targeted approaches to cancer therapy.
Harnessing the power of technology, biotechnology as a field emerged with the purpose of developing or creating different products by using biological systems, living organisms or parts of these. One of the leading applications of biotechnology involves the production of therapeutic proteins and other drugs such as monoclonal antibodies and vaccines through genetic engineering.8
In recent decades, the understanding of cancer has improved tremendously. Developments in cancer biotechnology have led researchers to learn about the genetic basis of cancer growth and minute molecular changes that occur in these cells. The discovery of oncogenes, tumour suppressor genes and the development of genome editing tools such as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) have revolutionised cancer detection and treatment.9 Other areas of research include mechanisms by which cancer cells avoid the body’s innate and adaptive immune system.10
By understanding the changes in the DNA of cancer cells, the types of proteins produced, and overall tumour biology, patient-specific and targeted treatment methods that are more effective than conventional ones can be devised. Researchers have developed targeted therapies in this manner, which aim to interfere with a specific process in the development of cancer.11 Another example of precision therapy includes immunotherapy, which strengthens the immune system of the patient to fight cancer more effectively.12
Biotechnology has also been widely applied in the development of affordable screening tools for early cancer detection and prevention. For this, biomarkers are of paramount importance. They are proteins, genes or other substances that are produced by the patient and can provide information about the cancer. One such example is HER2-positive breast cancer, where patients with high levels of the HER2 protein suffer from more aggressive disease.13 Studies have found that each patient may present with varying levels of biomarkers depending on the type of cancer and its severity. While certain biomarkers help to refine cancer therapy and prognosis, others aid in the diagnosis and monitoring of the patient under treatment.14
Gaps in Cancer Care & Drug Development
In addition to the growing cancer burden, survival rates in some Asian countries are lower compared to others and the global average. For example, for patients with lung cancer, 5-year survival rates were 8 times greater in Japan than in India. Similarly, 5-year survival rates for breast cancer were 90% in the United States and about 66% in Malaysia and India.15 With advances in screening, detection and treatment, survival rates are likely to improve. With these scientific advancements and breakthroughs, cancer has been transformed from a life-threatening disease to a chronic one with improved survival chances. However, affordability and accessibility to cancer therapeutics remain difficult, especially in low- and middle-income countries.
Effective cancer care is mainly dependent on adequate healthcare investment. In many markets across Asia-Pacific, access to cancer treatment is limited which, in turn, affects patient outcomes. The total health expenditure of middle-income countries was approximately 4% of the Gross Domestic Product (GDP) in 2018, compared to 8% in high-income markets. Evidence also suggests that high-income markets spent about 5 to 9% of their health budget on cancer care but it was as low as 1 to 2% in countries like Thailand and Indonesia.16
Moreover, the cancer drug development cycle involves years of research and millions of dollars are spent from the initial stages of research to identify the compound or design of the drug, discover its mode of action, and generate preclinical data. From this stage to regulatory approval can take up to 8 years and often, only 16 to 19% of drugs that undergo clinical trials make it to the market, pushing up drug costs. In countries with resource constraints, most of these costs are borne by the patient, which makes them prohibitively expensive.17 Nearly half of cancer patients and their families in low and middle-income areas face financial crises because of this.16
Thus, policymakers often need to balance the healthcare budget with access to affordable treatments and develop sound procurement strategies for each drug to benefit cancer patients and improve outcomes.
Addressing Gaps Through Innovation
The rise in cancer incidence coupled with resistance has made innovation the need of the hour. Rapid scientific advancements indicated by progress in molecular biology have given a deeper insight into cancer at a molecular level. This has facilitated the development of dedicated therapies that target molecular aberrations and other disruptions in cancer cells. In 2021, 47% of the biotherapeutic drugs under various stages of development were for cancer treatment. Moreover, clinical trials featuring drug combinations focused on nearly 300 different targets and pathways.18 This highlight that emphasis is increasingly placed on these therapies to enhance patient care.
While clinical trials are an essential part of the cancer drug discovery process, they can be costly and time-sensitive as well. As such, a well-designed clinical trial can ultimately reduce the cost of the drug for patients. The therapy can be designed to deliver multi-faceted inhibition that can mitigate cancer resistance. Moreover, to cater to patient-specific needs, combinations of designs can also be explored. These novel designs along with the help of biomarkers and small molecules can help fast-track drug development and make it more cost-efficient. Digitisation along with the rise of precision biotechnology has the potential to reduce high costs in therapeutics by focusing on targeted treatment plans that can ultimately deliver optimal outcomes for patients.
Biotech companies are frontiers of innovation in this space. AUM Biosciences, for example, has been developing a portfolio of precision cancer therapeutics through innovative clinical trial design to identify niches where these drugs can provide maximal impact to benefit patients. Understanding the importance of biomarkers in treatment, AUM Biosciences uses the “No biomarker, No drug” mandate to create patient-specific care plans.19
Biotechnology the Future of Cancer Treatment
Innovation is essential when it comes to research and development in identifying and treating cancer. The future of cancer treatment is likely to be biotherapy-based. Biotech researchers and biopharma companies must continue to work at the molecular level to develop therapies to help patients manage cancer.
The complexity of cancer and its unique trajectory in each patient defies the application of the “one size fits all” approach. Thus, the goal of precision medicine is to create a platform for the development of treatment modalities which suit the unique needs of those suffering from cancer and offer a new ray of hope. Moreover, applying innovative strategies to ensure the optimal clinical trial design and tailored treatment plans can help to reduce the overall cost of a drug, allowing the treatment to reach more patients. In Asia, where accessibility and affordability of cancer care are key issues, such strategies will be beneficial in improving patient outcomes. [APBN]
About the Author
Vishal Doshi, Chairman & CEO, AUM Biosciences
As an advocate of precision medicine to improve patient outcomes, Vishal Doshi successfully led AUM from a pre-clinical to a clinical stage company within 12 months of its inception. In 2019, he was awarded Asia-Pacific Biotech Entrepreneurial Company of The Year by Frost and Sullivan and was nominated as a Young Global Leader by the World Economic Forum in 2021.